Gil Ziv, Fliss Dan M
Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Plast Reconstr Surg. 2005 Aug;116(2):395-8; discussion 399. doi: 10.1097/01.prs.0000172761.65844.d0.
Classic craniofacial resection and the subcranial approach are well-established techniques for the removal of tumors involving the anterior skull base. These techniques require frontal craniotomy to allow broad exposure of the anterior cranial fossa, a procedure that may be further complicated by local infection and osteomyelitis or because of a reduction in tissue perfusion and direct communication between the osteotomy and the contaminated nasoethmoidal cavity. The authors present a new method for wrapping of the frontal bone segment with a pericranial flap with the intention of preventing these serious complications.
By means of this new approach, the frontonaso-orbital bone segment is removed, the frontal sinus bone is cranialized, and the frontonaso-orbital segment is repositioned in its original anatomical place following tumor extirpation. Wrapping is accomplished by a double-sided covering of the bone segment with the pericranial flap. This vascularized tissue is guided underneath the bony segment to cover the intranasal surface and then is externalized over the entire frontal area. The frontonaso-orbital segment and its overlying pericranial flap are fixed with the prebent titanium plates.
To date, the authors have performed 20 subcranial operations for resection of malignant tumors of the anterior skull base using this technique. None of these patients developed bone flap necrosis or osteomyelitis following radiotherapy. In the authors' hands, the rate of osteoradionecrosis was significantly lower in patients undergoing malignant subcranial tumor resection with pericranial wrapping than in those operated on before the study was activated (0 percent versus 20 percent, respectively; p = 0.056).
Pericranial wrapping is suitable for patients undergoing extirpation of anterior skull base tumors and for whom perioperative radiotherapy is recommended and for patients who have undergone multiple surgical procedures.
经典颅面切除术和颅下入路是切除累及前颅底肿瘤的成熟技术。这些技术需要额部开颅以充分暴露前颅窝，而该手术可能因局部感染和骨髓炎或因组织灌注减少以及截骨与受污染的鼻筛腔直接相通而进一步复杂化。作者提出一种用颅骨膜瓣包裹额骨段的新方法，旨在预防这些严重并发症。
通过这种新方法，切除额鼻眶骨段，将额窦骨颅化，肿瘤切除后将额鼻眶段重新置于其原始解剖位置。包裹通过用颅骨膜瓣双面覆盖骨段来完成。将这种带血管的组织引导至骨段下方以覆盖鼻内表面，然后在整个额部区域外翻。用预弯钛板固定额鼻眶段及其上方的颅骨膜瓣。
迄今为止，作者已使用该技术进行了20例颅下手术以切除前颅底恶性肿瘤。这些患者在放疗后均未发生骨瓣坏死或骨髓炎。在作者的经验中，采用颅骨膜包裹进行颅下恶性肿瘤切除的患者骨放射性坏死发生率明显低于研究开始前接受手术的患者（分别为0%对20%；p = 0.056）。
颅骨膜包裹适用于接受前颅底肿瘤切除且建议进行围手术期放疗的患者以及接受过多次手术的患者。
